#Humans of Karachi

[beenasarwar]

As war drums again beat between nuclear-armed Pakistan and India, remembering three departed comrades who stood for peace

[da-ni-a]

Organized Chaos: Karachi, Traffic and People

In the middle of the road and the most chaotic traffic you will ever encounter, a man leaves his car, motions the truck right behind his car to pause. He then goes around and pulls up the bonnet to examine the car batteries. It’s chaos. Eager to rest my head on a pillow the last thing I wanted was to not reach home on time. Except it isn’t chaos. Our bus goes on undisturbed. The man has got…

[hiyaluronic]

Astarion: Does anyone know anything about humans?

Karlach: Never met one.

Wyll:

Astarion: Right, funny creatures. Don’t they seem to have those funny festivals-…

Karlach: OH! Hang on, Wyll, you’ve meet humans!

Wyll: No, no…

Astarion: Yes! That’s right you’re one of them! Well, before the whole-.

Karachi: Right, try not to mention it.

Wyll:

[reasonsforhope]

"Around the world, mangrove forests have undergone a decades-long decline that is just now slowing to a halt.

In Pakistan, by contrast, mangroves expanded nearly threefold between 1986 and 2020, according to a 2022 analysis of satellite data.

Experts attribute this success to massive mangrove planting and conservation, as well as concerted community engagement.

Many in Pakistan are looking to mangroves to bolster precious fish stocks and defend against the mounting effects of climate change — even as threats to mangroves, such as wood harvesting and camel grazing, continue with no end in sight."

"His sandaled feet drenched in black mud, Rashid Rasheed points to one of the mangrove nurseries he’s been looking after for the past few years. With wooden walls topped by green netting, a dozen nurseries shelter thousands of saplings.

Rasheed, a researcher and nursery expert with the government of Balochistan province in Pakistan, has been leading a drive to establish nurseries in the coastal town of Dam. The goal is to expand and enhance the town’s scattered patches of natural mangrove forest, which have shriveled due to human activities.

“These nurseries have 50,000 saplings that are ready to be transported to the creeks for planting” Rasheed tells Mongabay.

Rasheed’s work is part of a five-year project initiated in 2019 by the Chinese Academy of Sciences’ South China Sea Institute of Oceanography that has planted mangroves on 16 hectares (40 acres) at Dam, and at other sites in Balochistan and neighboring Sindh province.

It’s one of many projects aiming to restore Pakistan’s mangroves. These semiaquatic trees offer a host of benefits, such as protecting coasts against storms and rising sea levels, providing habitat for fish, birds, and other wildlife, sequestering carbon better than most other ecosystems on Earth, and sustaining the livelihoods of some 120 million people globally, according to the IUCN.

Around the world, mangrove forests have undergone a decades-long decline that’s just now slowing to a halt. But Pakistan bucks this trend. The country’s mangroves expanded from 48,331 hectares in 1986 to 143,930 hectares in 2020 (119,430 to 355,659 acres), a nearly threefold increase, according to a 2022 analysis of satellite data. “It is because of the constant endeavor by government and NGOs,” the analysis states, citing restoration, research, and awareness-raising campaigns “now being religiously carried out to conserve and regrow mangroves” by local, national and foreign bodies. Fishing communities, who depend on mangroves for fuel, shelter and as fish nurseries, are often key to the success of Pakistan’s mangrove restoration, providing the labor for planting and protection."

-via Mongabay, February 5, 2024

[notwiselybuttoowell]

Climate whiplash is already hitting major cities around the world, bringing deadly swings between extreme wet and dry weather as the climate crisis intensifies, a report has revealed.

Dozens more cities, including Lucknow, Madrid and Riyadh have suffered a climate “flip” in the last 20 years, switching from dry to wet extremes, or vice versa. The report analysed the 100 most populous cities, plus 12 selected ones, and found that 95% of them showed a distinct trend towards wetter or drier weather.

The changing climate of cities can hit citizens with worsened floods and droughts, destroy access to clean water, sanitation and food, displace communities and spread disease. Cities where the water infrastructure is already poor, such as Karachi and Khartoum, suffer the most.

Cities across the world are affected but the data shows some regional trends, with drying hitting Europe, the already-parched Arabian peninsula and much of the US, while cities in south and south-east Asia are experiencing bigger downpours.

The analysis illustrates the climate chaos being brought to urban areas by human-caused global heating. Too little or too much water is the cause of 90% of climate disasters. More than 4.4 billion people live in cities and the climate crisis was already known to be supercharging individual extreme weather disasters across the planet.

Rising temperatures, driven by fossil fuel pollution, can exacerbate both floods and droughts because warmer air can take up more water vapour. This means the air can suck more water from the ground during hot, dry periods but also release more intense downpours when the rains come.

“Our study shows that climate change is dramatically different around the world,” said Prof Katerina Michaelides, at the University of Bristol, UK. Her co-author, Prof Michael Singer at Cardiff University, described the pattern as “global weirding”.

“Most places we looked at are changing in some way, but in ways that are not always predictable,” Singer said. “And given that we’re looking at the world’s largest cities, there are really significant numbers of people involved.”

Coping with climate whiplash and flips in cities is extremely hard, said Michaelides. Many cities already face water supply, sewage and flood protection problems as their populations rapidly swell. But global heating supercharges this, with the often ageing infrastructure in rich nations designed for a climate that no longer exists, and more climate extremes making the establishment of much-needed infrastructure even harder in low income nations.

The researchers have worked in Nairobi, Kenya, one of the cities suffering climate whiplash. “People were struggling with no water, failed crops, dead livestock, with drought really impacting their livelihoods and lives for multiple years,” Michaelides said. “Then the next thing that happens is too much rain, and everything’s flooded, they lose more livestock, the city infrastructure gets overwhelmed, water gets contaminated, and then people get sick.”

Sol Oyuela, executive director at NGO WaterAid, which commissioned the analysis, said: “The threat of a global ‘day zero’ looms large – what happens when the 4 billion people already facing water scarcity reach that breaking point, and the food, health, energy, nature, economies, and security that depend on water are pushed to the brink?”

[daydreaming-in-moonlight]

Pakistan violates ceasefire agreement within 3 hours after POTUS Donald Trump announces about ceasefire on Twitter.

India this. India that. "RW Hindutva propaganda and aggression is killing Pakistanis" 😭😭😭😭 Indiaa baaaaad.

.

.

Bruh, which country violates ceasefire agreement within 3 hours with Daddy Trump presiding over the ceasefire talks??? Has Pakistan not got a single person left who thinks with a clear mind and can think for more than 2 days in advance??? What on Earth possessed them to send attack drone towards Srinagar and restart the shelling???

How much pathetic does a nation have to be in order to do this? Where are the defenders of that rogue terrorist breeder nation that says that Modis India thinks everyone in Pakistan is a terrorist? Everyone might not be a terrorist, but everyone in that country is mad, that`s for sure. The DGMO of Pakistan called up the DGMO of India and talked (read: begged) for ceasefires. At 5.00pm IST sharp, the ceasefire was implemented. People in Srinagar in J&K, started going out onto the roads like normal and right now they are running for cover from the drone attacks.

I remember someone on Tumblr saying that they would become a Jihadist if Karachi is targeted. Bruv, you have to become a Jihadist because your country will force you to even if you don`t want to. Pak Defence Minister, Khwaja Asif said in the parliament that " Madrassa students are Pakistan`s second line of defence..."💀💀💀💀💀💀

The sheer madness and rogue nature of the country and its official is beyond human imagination.

[book-challenger]

Travel Destination: Pakistan

Written in the Stars by Aisha Saeed

Naila's conservative immigrant parents have always said the same thing: She may choose what to study, how to wear her hair, and what to be when she grows up-but they will choose her husband but when Naila falls in love with a boy Saif, her parents are livid and plan a vacation back to their homeland so Naila can reconnect with her roots.

However plans change and this vacation quickly turns to a nightmare when her parents find her a husband, Naila is running out of time, has Naila's fate been written in the stars? Or can she still make her own destiny?

Nura and the Immortal Palace by M.T. Khan

Nura must spend her time Mica mining for extra cash to support her family, however there’s rumours of treasure that could not only change her life but her family’s.

Her plan backfires when the mines collapse and four kids, including her best friend, Faisal, are claimed dead. Nura refuses to believe it and shovels her way through the dirt hoping to find him. Instead, she finds herself at the entrance to a strange world of purple skies and pink seas—a portal to the opulent realm of jinn, inhabited by the trickster creatures from her mother’s cautionary tales.

Under the Tamarind Tree by Nigar Alam

1964. Karachi, Pakistan. Rozeena is running out of time. She'll lose her home—her parents' safe haven since fleeing India and the terrors of Partition—if her medical career doesn't take off soon. But success may come with an unexpected price. Meanwhile the interwoven lives of her childhood best friends—Haaris, Aalya, and Zohair���seem to be unraveling with each passing day. The once small and inconsequential differences between their families' social standing now threaten to divide them. Then one fateful night someone ends up dead and the life they once took for granted shatters.

The Women’s Courtyard by Khadija Mastur

Set in the 1940s with Partition looming, Aliya dreams of educating herself and venturing beyond the courtyard walls, however she surrounded by the petty squabbles of her household.

Aliya must endure many trials before she achieves her goals, though at what personal cost?

An Abundance of Wild Roses by Feryal Ali-Gauhar

In a land woven with myth, chained with tradition and afflicted by war and the march of progress, the spirits of the mountains keep a baleful eye on the struggles of the villagers who scrape a living from the bodies of their wildlife. As the elements turn on the village, can humanity find a way to co-exist with nature that doesn't destroy either of them?

[lgbtqiamuslimpedia]

Muhsin Hendricks

Birth : Unknown

Ethnicity : South Asian, African

Alumni : University of Islamic Studies, Karachi (1990-1994)

Gender : Cisgender man

Sexuality : Gay

Occupation : Imam, scholar, activist

Muhsin Hendricks is an Islamic scholar, researcher & human rights activist.He is allegedly the world's first openly gay Imam. He has done independent research on Islam and sexual diversity, an area that does not often get explored in the Muslim/Islamic world. He has also delivered many papers and facilitated workshops on Islam and Sexual Diversity to many organizations in South Africa, USA and Europe. Muhsin is founder of The Inner Circle/Al-fitrah Foundation, the largest organization for LGBTQI+ Muslims in Africa & CCI Network, a network of inclusive muslims, faith leaders & activist. He founded the first gender-affirming, queer-friendly mosque in South Africa (the mosque is affiliated with organization Al-fitrah Foundation).

[thelifeofjoun]

The reality around me feels like a disorder in the real, for we have constructed it not with critical thought, but through imitative behavior. In doing so, we've substituted genuine reality with the imaginary and the symbolic, creating a perpetual loop of hyperreality.

I find myself unable to reconcile with this fabricated world, as it exists in a constant state of chaos. Every interaction, every observation, and every moment spent with others only deepens my sense of alienation, embellishing my awareness of the fragility and dissonance inherent in the human condition. In a city like Karachi, where the pulse of life relentlessly beats, I cannot help but perceive its people as inhabiting a 'modest-graveyard of humanness'—a colony not of free individuals, but of souls (in it's very materiality) trapped in an endless cycle of societal decay, denseness and, cold.

This sense of disconnection is only intensified after engaging with spaces like LinkedIn, where the ceaseless chase for superficial success and hollow aspirations further alienates me from the raw, authentic human experience.

[beenasarwar]

Pakistani minority rights activists renew demands for justice after attacks on churches

The attacks on the Christian community in Jaranwala near former Lyallpur are among a long string of such violence instigated by extremist elements seeking power in the name of religion in Pakistan. My article for Sapan News with Abdullah Zahid in Karachi

The attacks on the Christian community in Jaranwala near Faisalabad (former Lyallpur) are among a long string of such violence instigated by extremist elements seeking power in the name of religion in Pakistan. I co-wrote this article for Sapan News with a young reporter in Karachi who was initially only reporting on Pakistan’s first Minority Rights March. Then Jaranwala happened. We now present…

[mariacallous]

Humanity’s superpower is sweating—but rising heat could be our kryptonite, and an average temperature rise of 2 degrees Celsius above preindustrial levels could bring regular, fatal heat waves to large parts of the planet, says Tom Matthews, a senior lecturer in environmental geography at King’s College London.

“We have evolved to cope with the most extreme heat and humidity the planet can throw at us,” he explains. But when our core temperature gets to about 42 degrees Celsius (around 107.5 degrees Fahrenheit), people face heat stroke and probable death as the body strains to keep cool and the heart works harder, inducing heart attacks.

Matthews cites an example from his home country, the UK. In the summer of 2022, the UK broke its high temperature record, surpassing 40 degrees Celsius (104 degrees Fahrenheit). Scientists estimate there were roughly 3,500 heat-associated deaths that summer in the UK. Across Europe, they estimate high heat caused more than 60,000 deaths.

“At 1.5 degrees Celsius of warming, the likes of Lagos, Karachi, [and] Shanghai start to experience heat waves exceeding our limit. At 2 degrees Celsius, the events increase at least 10 times more often, and if we get to 8 degrees Celsius, a large fraction of the Earth’s surface would be too hot for our physiology and would not be habitable,” he says.

Air conditioning and heat-escape rooms would help, but we might need to abandon intense outdoor work such as rice farming in hotter regions. And these solutions will need to be able to meet demand. “The infrastructure must be able to withstand the surges when everyone turns on the air conditioning, and must be able to withstand hurricanes or floods,” he says.

Our best hope in the face of inevitable rises in heat? Cooperation. “We’ve built forecasting systems that will warn us when disasters are incoming by working together at enormous scale. We must continue to do the same.”

[therainbowarchives]

savor: a chef's hunger for more

type: memoir

author: fatima ali

date of release: october 11, 2022

synopsis:

a young chef whose dreams were cut short savors every last minute as she explores food and adventure, illness and mortality in this stunning, lyrical memoir and family story that sweeps from pakistan to new york city and beyond.

"savor is moving, heartbreaking, and defiantly hopeful."--mohsin hamid, new york times bestselling author of the last white man and exit west

fatima ali won the hearts of viewers as the fan favorite of bravo's top chef in season fifteen. twenty-nine years old, she was a dynamic, boundary-breaking chef and a bright new voice for change in the food world. after the taping wrapped and before the show aired, fati was diagnosed with a rare form of bone cancer. not one to ever slow down or admit defeat, the star chef vowed to spend her final year traveling the world, eating delicious food, and making memories with her loved ones. but when her condition abruptly worsened, her plans were sidelined. she pivoted, determined to make her final days count as she worked to tell the story of a brown girl chef who set out to make a name for herself, her food, and her culture.

including writing from fatima during her last months and contributions by her mother, farezeh, and her collaborator, tarajia morrell, this deftly woven account is an inspiring ode to the food, family, and countries fatima loved so much. alternating between past and present, readers are transported back to pakistan and the childhoods of both fatima and farezeh, each deeply affected by cultural barriers that shaped the course of their lives. from the rustic stalls of the outdoor markets of karachi to the kitchen and dining room of meadowood, the acclaimed three-star michelin restaurant where she apprenticed, fati reflects on her life and her identity as a chef, a daughter, and a queer woman butting up against traditional views.

this triumphant memoir is at once an exploration of the sense of wonder that made fatima so special, and a shining testament to the resilience of the human spirit. at its core, it is a story about what it means to truly live, a profound and exquisite portrait of savoring every moment.

availability:

internationally distributed, available at liberty, readings, etc.

pins:

[reasonsforhope]

"Nasir Mansoor has spent 40 years fighting for Pakistan’s workers. Whether demanding compensation on behalf of the hundreds of people who died in a devastating 2012 factory fire in Karachi or demonstrating against Pakistani suppliers to global fashion brands violating minimum wage rules, he’s battled many of the country’s widespread labor injustices.

Yet so far, little has improved, said Mansoor, who heads Pakistan’s National Trade Union Federation in Karachi... Regulations and trade protocols look good on paper, but they rarely trickle down to the factory level. “Nobody cares,” Mansoor said. “Not the government who makes commitments, not the brands, and not the suppliers. The workers are suffering.”

Change on the Horizon

But change might finally be on the horizon after Germany’s new Supply Chain Act came into force last year. As Europe’s largest economy and importer of clothing, Germany now requires certain companies to put risk-management systems in place to prevent, minimize, and eliminate human rights violations for workers across their entire global value chains. Signed into law by German Chancellor Olaf Scholz in January 2023, the law covers issues such as forced labor, union-busting, and inadequate wages, for the first time giving legal power to protections that were previously based on voluntary commitments. Companies that violate the rules face fines of up to 8 million euros ($8.7 million)...

...As governments come to realize that a purely voluntary regimen produces limited results, there is now a growing global movement to ensure that companies are legally required to protect the people working at all stages of their supply chains.

The German law is just the latest example of these new due diligence rules—and it’s the one with the highest impact, given the size of the country’s market. A number of other Western countries have also adopted similar legislation in recent years, including France and Norway. A landmark European Union law that would mandate all member states to implement similar regulation is in the final stages of being greenlighted.

Although the United States has legislation to prevent forced labor in its global supply chains, such as the 2021 Uyghur Forced Labor Prevention Act, there are no federal laws that protect workers in other countries from abuses that fall short of forced labor. That said, a proposed New York state bill, the Fashion Act, would legally require most major U.S. and international brands to identify, prevent, and remediate human rights violations in their supply chain if passed, with noncompliance subject to fines. Since major fashion brands could hardly avoid selling their products in New York, the law would effectively put the United States on a similar legal level as Germany and France...

The Results So Far

As of January, Germany’s new law applies to any company with at least 1,000 employees in the country, which covers many of the world’s best-known fast fashion retailers, such as Zara and Primark. Since last January [Jan 2023], German authorities say they have received 71 complaints or notices of violations and conducted 650 of their own assessments, including evaluating companies’ risk management.

In Pakistan, the very existence of the German law was enough to spark action. Last year, Mansoor and other union representatives reached out to fashion brands that sourced some of their clothing in Pakistan to raise concerns about severe labor violations in garment factories. Just four months later, he and his colleagues found themselves in face-to-face meetings with several of those brands—a first in his 40-year career. “This is a big achievement,” he said. “Otherwise, [the brands] never sit with us. Even when the workers died in the factory fire, the brand never sat with us.” ...

-via The Fuller Project, April 2, 2024. Article headers added by me.

Article continues below, with more action-based results, including one factory that "complied, agreeing to respect minimum wages and provide contract letters, training on labor laws, and—for the first time—worker bonuses"

With the help of Mansoor and Zehra Khan, the general secretary of the Home-Based Women Workers Federation, interviews with more than 350 garment workers revealed the severity of long-known issues.

Nearly all workers interviewed were paid less than a living wage, which was 67,200 Pakistan rupees (roughly $243) per month in 2022, according to the Asia Floor Wage Alliance. Nearly 30 percent were even paid below the legal minimum wage of 25,000 Pakistani rupees per month (roughly $90) for unskilled workers. Almost 100 percent had not been given a written employment contract, while more than three-quarters were either not registered with the social security system—a legal requirement—or didn’t know if they were.

When Mansoor, Khan, and some of the organizations raised the violations with seven global fashion brands implicated, they were pleasantly surprised. One German retailer reacted swiftly, asking its supplier where the violations had occurred to sign a 14-point memorandum of understanding to address the issues. (We’re unable to name the companies involved because negotiations are ongoing.) The factory complied, agreeing to respect minimum wages and provide contract letters, training on labor laws, and—for the first time—worker bonuses.

In February [2024], the factory registered an additional 400 workers with the social security system (up from roughly 100) and will continue to enroll more, according to Khan. “That is a huge number for us,” she said.

It’s had a knock-on effect, too. Four of the German brand’s other Pakistani suppliers are also willing to sign the memorandum, Khan noted, which could impact another 2,000 workers or so. “The law is opening up space for [the unions] to negotiate, to be heard, and to be taken seriously,” said Miriam Saage-Maass, the legal director at ECCHR.

Looking Forward with the EU

...Last month [in March 2024], EU member states finally approved a due diligence directive after long delays, during which the original draft was watered down. As it moves to the next stage—a vote in the European Parliament—before taking effect, critics argue that the rules are now too diluted and cover too few companies to be truly effective. Still, the fact that the EU is acting at all has been described as an important moment, and unionists such as Mansoor and Khan wait thousands of miles away with bated breath for the final outcome.

Solidarity from Europe is important, Khan said, and could change the lives of Pakistan’s workers. “The eyes and the ears of the people are looking to [the brands],” Mansoor said. “And they are being made accountable for their mistakes.”"

-via The Fuller Project, April 2, 2024. Article headers added by me.

[whatcha-thinkin]

All figures from World Population Review

[ms09bd]

The Fiery March of 1971: A Day of Resistance and Sacrifice

On March 5, 1971, the flames of resistance burned brighter as the people of Bangladesh stood against oppression. On this day, four workers were martyred, and 25 others were injured when armed forces opened fire during a strike in the Tongi industrial area. The entire region erupted in outrage, with protesters setting fire to the wooden bridge near the concrete one and blocking roads with fallen trees.

News of the workers’ deaths spread swiftly to Dhaka, sparking mass unrest. The Chhatra League organized a massive procession, carrying the bodies of the slain workers through the capital. Meanwhile, Chittagong witnessed protests, public gatherings, and a complete shutdown in mourning for the martyrs.

By evening, the government announced that the army had been withdrawn to the barracks in Dhaka. Following Bangabandhu Sheikh Mujibur Rahman’s directives, banks remained open despite the strike. Special prayers were held in mosques across the country for the souls of the martyrs. Protest meetings and rallies took place nationwide, with writers and artists joining in from the Pakistan Writers’ Association office on Topkhana Road to the Central Shaheed Minar, where they took an oath for the liberation of Bengal under the leadership of Dr. Ahmad Sharif.

On the political front, Pakistan People’s Party chairman Zulfikar Ali Bhutto held over five hours of discussions with President Yahya Khan at the Rawalpindi Presidential Palace. Retired Air Marshal Asghar Khan arrived in Dhaka from Karachi and met with Bangabandhu at his Dhanmondi residence that night.

Later in the evening, Bangabandhu denounced foreign radio reports suggesting he was willing to share power with Bhutto, calling them ‘ill-intended’ and ‘a fabrication.’ Awami League General Secretary Tajuddin Ahmad issued a statement condemning the military’s indiscriminate killing of innocent, unarmed civilians, including workers, farmers, and students. He declared such atrocities as crimes against humanity.

Milon Syed

[flyonthewallmedstudent]

Bartonella henselae

Case Report:

23M veterinary student from home with a cat, presents with a one year history of neck swelling, 1 month of fevers and lethargy. Also he lives in Karachi.

The fevers are a/w chills and rigours that response to paracetamol and have no particular pattern to them.

He doesnt have any arthralgias or arthritis or rash.

They find pretty sizable lymph nodes on exam in the cervical chain and inguinal regions.

He starts developing hypotension and they start him on some vasopressors and meropenem.

The fevers don't respond, and someone decides to start azithromycin, which it does respond to.

He's also worked up for IE given the chronicity of events.

Eventually on biopsy of the lymph node, the lab finds bartonella hensalae.

Microbiology + transmission:

aka cat scratch fever, so this is why history is so important to infectious diseases physicians.

it's actually disease of cats that can spread to their humans via bites and scratches. Or the cat licks a wound etc.

and unfortunately also via arthropod vectors and mossies

after entry into a host, it's main target cells are CD34s, immune cells, and then alters the host immune system

it's interesting special power is that it can predispose hosts to other pathogens in this manner

it's a gram negative rod (pink rods)

Historical trivia

the fun bits

genus of Bartonella is named for a Peruvian scientist (Alberto Barton, also had interest in brucellosis and leishmaniasis --> other tropical diseases taht cause fevers of unclear origin), he isolated the bacteria from patients during an outbreak among railway works in South america. This was 1905.

reminds me of love in the time of cholera, when people still wrote physical letters.

species of bartonella henselae is actually named for Diane Henselae, a researcher from Oklahoma, who collected samples during an outbreak there in the mid 1980s.

rare for someone who discovered a species named for them to be both alive and a woman, and I can't find much about her online.

there are other bartonella species that cause historically significant diseases like trench foot (bartonella quintana, transmitted by lice) and carrion's disease (bartonella bacilliformis, with a high mortality rate). another post for another day.

Clinical features

incubation period: up to 10 days

initial: rash at site of injection or intro of pathogen, from there it travels to local lymph nodes causing lymphadenopathy about 1-3 weeks later

From CDC guidelines who took image from NEJM

Bsymptoms - low grade fevers/malaise/fatigue

epidemio: occurs most often (for a rare disease) in kids < 15

Complications

infection affecting the eye (neuro-retinitis = visual changes, irritation and photophobia), liver, spleen, brain/spine (transverse myelitis, encephalitis etc), bones and heart valves (IE)

Increased risk groups for complications

HIV/AIDs, immunocompromised hosts (i.e. transplants), mortality is an issue in this group, as disseminated disease a possibility

small risk of IE in groups with RFs for develop this (prosthetic valves, damaged valves, unrepaired congential heart disease etc)

Investigations

challenging, no gold standard test as the sens and spec is variable for each individual one, so it's a combination really, of history exam and a variety of confirmatory tests

PCR (variable spec/sens), serology (indirect and often negative in early stages, can also be positive for years post treatment and doesn't differentiate from other bartonella species), cultures are definitive but it can take 21 days for anything to grow (it's fastidious)

histopath of lymph nodes helpful - stains: silver stain or Warthin Starry stain (silver nitrate) which is kind of a reverse starry starry night used for spirochetes like helicobacter.

in IE, it can be culture negative, which can confuse diagnosis

From Wiki

Management

mild disease is self resolving

first line: few days azithromycin or doxycycline can reduce symptoms and is indicated for enlarged lymph nodes to reduce size or unresolving LAD >1 month

in case of eye infection or IE expect longer duration of hterapy, like doxy and rif for 4-6 weeks

will also respond to bactrim, cipro, rif and gent

Prevention from the CDC:

avoid strays, wash hands after petting cats, keep strays from your cat, avoid owning new kittens who are < 1 yr if you are immunocompromised

avoid getting scratched..which is kinda hilarious but can see why

Sources

stat pearls

case report above

wikipaedia

Rare diseases

CDC guidelines